Night Shift Nursing Education and Effects on Job Satisfaction

This study was conducted to provide convenient access to employer-required education which is frequently not available during the normal work hours of the night shift nurses. A pre- and post-test job satisfaction survey was performed and tested for significance. The results indicated a positive influence on job satisfaction with the highest confidence level.

A Capstone Prospectus Presented to the Faculty of the Department of Nursing of Western Governors University In Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing Education Specialty

Abstract

Continuing nursing education, professional development, and employer-required annual competencies is expected and often mandated to retain employment and/or licensure. This inductive cross-sectional critical action design used mixed methods to examine the effect of offering required education during night time hours on job satisfaction. Voluntary involvement consisted of completing a pre-intervention Likert-scale job satisfaction survey, attendance at two facility-required courses conducted on night shift, and a post-intervention survey. Purposive sampling was utilized to gather nurses whose normal work hours were either evening or night shift. The intervention was attendance at a Basic Life Support Renewal course and a Surviving Sepsis competency review, which are commonly-required courses. The post-intervention Likert-scale job satisfaction survey revealed that attendance did have a positive impact on job satisfaction of the night shift nurses with a confidence level of p<.01. It is recommended that the facility continue to offer required education during the normal work hours of the night shift. It is also strongly recommended to expand this education to other facilities.

Acknowledgements

I would like to sincerely thank student mentor, Michelle Killingsworth, CNM, MSN for her assistance during most of my master's degree program. We were there for each other during some emotionally distressful personal life changes. More recently, Dr. Tori Canillas-Dufau, Jillian Reagan, and Christine Hadsell have been instrumental in the writing process of my Capstone.

To Alison Preston, RN MS; Gloria Castillo, RN MN and many of my colleagues, I appreciate your encouragement as well. To Linda J. Heitel-Dozier, RN MN, you were my first professional mentor. You are the ultimate example of a well-educated nursing professional with an unwavering commitment to academic and clinical excellence. No matter how long it was between our conversations, you always extended an encouraging word. I appreciate you!

My adult children - Davina Johnson, Kenneth Staples, and Charlene Chambers - you kept me motivated during this long process. To my dear friend, Alfred J. Marshall, DD, we encouraged each other through our seemingly unending academic pursuits. Wayne Hemphill, my Champion, I thank you for keeping me focused and making sure I did not get distracted from this goal. Lindzie Martin, my Precious Friend, your input is appreciated. Omega Mills, you kept me laughing when I felt like crying. I love you all!

Last, but certainly not least, I extend a posthumous heart-felt appreciation to my pastor, Dr. Billy G. Ingram, PhD. His constant encouragement to do what I love and his messages to live life to the fullest are the main reasons I made a career change. He truly practiced what he preached! I love you, PB. May you rest in eternal shalom.

Chapter 1: Introduction to the Problem

Introduction

There are many courses for nurses in professional development, continuing education, and employer-required annual competencies that are available (Education Resource Center). Of all bedside nurses, about half work evening shift from 1500-2330, traditional night shift from 2300-0730 or 12-hour night shift from 1900-0730. Since most of the available live nursing education is only offered during day hours, the evening and night shift nurses find themselves abruptly adjusting their sleep patterns to attend required courses. As a result, night shift nurses often have lower job satisfaction than their co-workers and experience a higher level of job-related stress (Golubic, Milosevic, Knezevic, & Mustajbegovic, 2009). After all, if nearly half the bedside nurses work at night, more required coursework should be made available during their normal work hours. The purpose of this study was to offer some required coursework at night, and showed that doing so had a statistically significant positive effect on job satisfaction, p < .01. Learner-input was used to determine what times the courses were offered, as well as offer suggestions for future classes.

Using an inductive cross-sectional critical action design with mixed methods, a Likert-scale job satisfaction survey (see Table 1) was administered to a randomly-selected purposive sample of day shift and night shift nurses. All participants were administered a Demographic Questionnaire (see Table 2). Only the evening and night shift nurses attended two employer required courses during the night shift and were asked to complete a post-intervention job satisfaction survey, and an unstructured interview (see Table 3). The interventions took place over approximately two months with both Basic Life Support (BLS) and Surviving Sepsis Competency courses presented at times suggested by the majority of the participants. This data supports the prediction that access to required coursework during the normal work hours of the night shift staff would positively impact job satisfaction. Responses from the unstructured questions were utilized to deliver additional employer-required courses during the night shift.

Topic Presentation

The topic for this Capstone was to offer commonly required courses at night and test for impact on job satisfaction. Purposive sampling was used to select participants whose normal work hours are at night from approximately 1900-0730 or evenings from 1500-2330. The researcher obtained participants from a home care company where she is on the Board of Directors, and from a major online nursing website where she is a member. The home care company is in a small coastal community surrounded by a large metropolis. The online nursing forum members live around the world. However, all respondents practice nursing in the United States.

Hospital-based educators and other nursing education providers have a vital role in developing and delivering evidence-based curricula that meets educational and regulatory needs of their clients. Due to the increasing complexity and constant evolvement of health care, educators must find innovative methods to reach and teach their colleagues (Benner, 2012). It can be a daunting challenge to remain relevant with both content and delivery methods. Continuing education is touted by nursing professionals so that nurses can implement best practices and achieve excellent patient outcomes (NursingWorld, 2013). Perhaps the most challenging aspect is for educators to ensure that whatever is taught in the classroom leads to patients becoming and staying healthier (HealthyPeople2020).

With increasing employer demand for nurses to obtain academic advancement and specialty certifications, there has been an increasing demand for educators who are academically prepared, with a graduate degree in nursing preferred among many acute facilities.

Topic Choice

The topic of how night time attendance affects job satisfaction is an intriguing subject to this author. Her first nursing position was on 12-hour night shift, and she needed to attend employer-required classes. Since these classes were not offered at night, she and her co-workers expressed dissatisfaction with the lack of conveniently scheduled classes. During her undergraduate coursework, this author decided to teach one required class at night. Her co-workers were delighted about this. In fact, the response was so positive that this author started an entrepreneurial venture that focused on providing nursing-related courses at night.

Topic Impact

As previously stated, employer-required courses are nationwide. Nearly two-thirds of the State Boards of Nursing require 30 hours of Continuing Education (CE) biannually for nurses to renew their licenses (NCSBN.org). Even with the convenience of online courses, there are many nursing skills that must be demonstrated in person. Many full-time hospital-based Nurse Educators work Monday-Friday 0800-1730. This leaves a sizable portion of the bedside work force with precious little convenient access to courses, which is a given for their dayshift counterparts.

The topic of nursing education and its connection to job satisfaction is important because failure to address these needs contributes to more frequent attrition among night shift (Mayes & Schott-Baer, 2010; Gustafsson, Fagerberg, & Asp, 2010). Night shift nurses feel less valued and isolated from their dayshift co-workers (Campbell, Nilsson, & Pilhammar-Andersson, 2008). The author had some personal empirical results from providing education at night, and decided that the topic merited graduate-level research. She believed that her colleagues would benefit from the study as well.

Problem Statement

Less than one-third of the employers represented in the survey offered Annual Competency in an online format. Only two of the participants attended any live coursework during night hours. Some employers enforced completion of Annual Competencies by suspending nurses from working until courses were complete (Norwood, personal communication, February 2013). Being left with few options to attend classes, the nurses disrupted their already-skewed sleeping patterns to be awake, alert and attempt to master material during daytime hours (Norwood, personal communication, February 2013). Night shift and evening shift employees then often have lower job satisfaction than their day shift counterparts (Gustafsson, et al., 2010; Mayes & Schott-Baer, 2010). Registered Nurses (RN's) are required to complete Annual Competency coursework to be in compliance with the policies of their employer. Of all the non-managerial nurses working in the acute care environment, one-third work night shift from 1900-0730 (Blachowicz, 2006; Claffey, 2006). Since about a third of nurses work at night, more required courses need to be made conveniently accessible to them.

Rationale and Significance of Study

In the past two years, some night time in-services and skills demonstrations have been provided by the Clinical Nurse Educator of one facility surveyed. However, the consistency, availability and content of these in-services have been sporadic at best. Although there is computerized self-study software in place at that facility, the skill demonstrations must be done in person. Additionally, partly due to paper tracking methods and partly due to other job demands of the Educator, a lot of manpower was involved to ensure courses were delivered to all the per diem and part-time staff (Sousa, personal communication, October 2012). In short, there have been few learner-driven courses and certainly fewer still delivered on night shift when almost half of the bedside nurses are working. The subject area was annual competencies, BLS courses, and disease-specific standards of care. The level was for all professional nurses. The cause of the problem is lack of required courses which are offered during night hours.

Research Questions

The research questions were: How will offering required coursework at night affect job satisfaction? Further, is there a statistically significant difference in job satisfaction between the shifts? Secondly, what kind of courses/training could feasibly be offered during the evening and night hours?

Purpose of the Study

The purpose of this cross-sectional critical action research project was to implement required nursing courses during the normal work hours of the night shift nurse, and to test for significant positive effect on job satisfaction after the intervention. In an initial phase of developing required curricula offered at night, a need was ascertained to investigate types of nursing courses accessed, staff's perception of facility-offered education and the effect of facility-delivered education on job satisfaction. The level of focus is cross-sectional.

Lack of access to required education is a major problem for night shift nurses. Studies indicate that night shift nurses have more health problems, lower job satisfaction, and report more stress than their day shift counterparts (Cooper, 2003; Campbell et al., 2008; Keller, 2009). Although there is a great deal of education offered during day time hours, the night shift nurses endure more stress because they must abruptly adjust their sleep schedules to attend available classes. The purpose of this research was to offer required education during the normal work hours of night shift, and test for a statistically significant improvement in job satisfaction.

Chapter 2: Literature Review

Introduction

Professional peer-reviewed journals were reviewed and utilized in this paper. All the articles were relevant to this paper. Some articles were specific to nursing education at night. Although most literature reviewed was not specifically about education at night, it was selected because of common challenges faced by night shift work. Search terms such as night shift, education, training, annual competencies, and job satisfaction were chosen. About half of the sources were within five years old. Older articles were selected because of their relevance to this study. The credentials and affiliations of the authors were examined. Many of the authors had university or fellow affiliations, and a few were frequent contributors to nursing education and advanced practice nursing journals.

Although several of the studies were conducted in the United States and Canada, other countries were also represented, such as Australia, Croatia, Sweden, England, and France. Access to staff development and professional education on night shift is limited in these other countries as well. Therefore, it was considered important to include studies from these additional countries.

Educational Requirements

Boards of Registered Nursing (BRN) requirements for obtaining licensure as an RN vary widely among the states. Some, like California, permit licensure after completing an Associate Degree program. Others like Kansas often have entry-level Bachelor Degree programs (ksbn.org). All states mandate a passing score on the National Council of Licensure Examination (NCLEX) prior to becoming licensed as an RN (ncsbn.org). Additionally, the states differ in their requirement of Continuing Education (CE). For example, California requires nurses to take 30 hours of CE every two years (Board of Registered Nursing - License/Certificate Renewal). Missouri has no CE requirement (Board of Nursing). Nonetheless, almost every employer requires biannual American Heart Association (AHA) Basic Life Support (BLS) as well as Annual Competencies. These can be related to patient safety, fire safety, medication administration, equipment training, etc. The Annual Competencies of one studied facility included HIPAA (http://www.hhs.gov/ocr/privacy/hipaa...acysummary.pdf), several courses to comply with The Joint Commission's (TJC) National Patient Safety Goals (http://www.jointcommission.org/asset...inal_10-23.pdf), and fire safety procedures (www.fireengineering.com).

Classroom =/= Clinical

In a landmark study, Patricia Benner reveals that an innovative change in nursing education is needed (Benner, Sutphen, Leonard, & Day, 2009.). This research found that nursing education often did not stay relevant with complexities of bedside practice (Benner, et al., 2009.). These authors recommended increased utilization of simulation, coaching, and one year of nursing residency (Benner, et al., 2009). Further, classroom preparation and clinical reality do not correlate (http://www.bestnursingdegree.com/int...atricia-benner).

Adults need to know the rationale behind the education (Gay, Mills, & Airasian, 2009). Adult learning is also retained longer if the learner can immediately implement what was learned (Gay, et al., 2009). Conversely, staff felt unprepared and uncertain when too much time had passed between education on operation of a new piece of equipment and actually using it (Sousa, personal communication, October, 2012). After mandating education on this new equipment, management decided to use up the supplies from the old machine first (Norwood, personal communication, November, 2012). The nurses expressed frustration that they were not informed of management's decision to delay utilizing this new machine (Norwood, personal communication, November, 2012).

Why Competency-based Education?

An Australian study published in 2012 found that using an online Learning Management System (LMS) simultaneously addressed several needs of the hospitals studied (Beavis, Morgan, & Pickering, 2012). Nursing staff completed their Annual Competencies in record time - 3 weeks vs. 10 months (Beavis et al., 2012). Some of the benefits realized included flexible delivery of the curricula, facilitation of collaborative learning, cost effectiveness, and allowed rapid tracking of scores and completion times (Beavis et al., 2012). Several barriers were also identified which included slow internet access, interruptions at the workplace, and access to computers at the workplace (Beavis et al., 2012). Student evaluations revealed that despite the barriers, the staff enjoyed having some control over when and where they took Annual Competencies (Beavis et al., 2012). Further, the Nursing Education staff discovered that the LMS relieved them from tedious follow-up with the floor nurses (Beavis et al., 2012). Nursing Educators commented that using the LMS was an adjunct to part-time and day hour human educators (Beavis et al., 2012).

Competency-based education has already been widely implemented in the nursing profession as beginning nursing instruction, assuring current practice competency, and in advanced practice as nursing management education (Lenburg, 1999; Paranhos & Mendes, 2010; Pillay, 2010). Further, competency-based education is one method utilized to guide a nurse's professional development (Donley & Flaherty, 2008). For a brief overview of the rationale driving competency-based education at the undergraduate and graduate level, one may visit the website of Western Governors University (http://www.wgu.edu/why_WGU/competency_based_approach). In short, this approach allows students to demonstrate competency in various subjects and earn their degrees quicker than with other methods (www.wgu.edu). Not only do competency-based courses allow quick completion, they also motivate the learner to immediately put the material into practice.

Although the general adoption of competency-based adult education is relatively new, the concept was perhaps initially discussed by Benjamin Bloom in 1956. Bloom postulated that a six-level hierarchy of learning exists (Clark, 2013). Competency-based education is focused on the third level, Application, and the fourth level, Analysis. These two levels correspond with the passing level of the NCLEX (ncsbn.org).

An example of a student-focused competency-based learning objective is: Student will demonstrate correct performance of measuring a client's blood pressure. Each of the three learning domains - cognitive, affective, and psychomotor - can be readily evaluated (Clark, 2013). The cognitive domain was assessed by asking the student to describe normal ranges for blood pressure. The affective domain was assessed by having the student discuss the patient's stress-related implications on blood pressure. The psychomotor domain was evaluated by observing the student checking a patient's blood pressure and obtaining results that are within five points of systolic/diastolic readings (McDonald, 2007).

Accessibility

A study by Barriball & While (1996) revealed that night shift nurses attend professional development and continuing education courses less frequently than their day shift counterparts. The authors also found that lack of consistently developed curricula and standardized assessment of educational effectiveness was a deterrent (Barriball & While, 1996). A more recent study highlights the lack of accessible continuing and professional education during night shift (Mayes & Schott-Baer, 2010). The specific learning needs of the night shift worker had not been adequately researched (Mayes & Schott-Baer, 2010). Further, one study indicated that on-duty night shift nurses cannot easily leave their units to attend courses (McCarthy, 2004). McCarthy devised a means to meet this need by bringing night time in-services directly to the night shift nurses (McCarthy, 2004). A Swedish study examined effective methods of educating night shift nurses (Campbell et al., 2008). It also illustrated the importance of teamwork as it relates to bedside nursing (Campbell, et al., 2008).

Slowed Recovery After 12-hour Shifts

In 2003, Cooper discussed the physical impact of working 12-hour shifts (Cooper, 2003). She accurately predicted that, by the year 2010, forty percent of active nurses would be at least 40 years old (Cooper, 2003). The body's ability to recover after working extended hours dramatically decreases after age 40 (Cooper, 2003). A newer study by Keller (2009) also revealed that innovative methods must be implemented to assist nurses to adapt to increasing work demands (Keller, 2009). Keller postulated that retention of older, more educated nurses depends on creative retention strategies (Keller, 2009).

Impact of Education After Dark

One source reviewed highlighted a case study of BLS training offered at night (Mayes & Schott-Baer, 2010). This source described the lack of access to education during night hours (Mayes & Schott-Baer, 2010). Post-education questionnaires revealed that staff was motivated and impressed about receiving required training at night (Mayes & Schott-Baer, 2010). Another article published in 2010 discusses the staff-initiated journal clubs that were attended by night shift nurses (Stewart, Snyder & Sullivan, 2010). This group decided when and how often to meet, as well as collaborated on discussions of evidence-based practice (Stewart et al., 2010). The staff was recognized by management because of their rapid implementation of the evidence-based practice (Stewart et al., 2010).

The Education-Job Satisfaction Connection

One of the international studies supported a theory that higher-educated nurses are more satisfied with their jobs (Golubic, Milosevic, Knezevic & Mustajbegovic, 2009). It supports the assertion that higher educated nurses attend more professional workshops than their less-educated counterparts (Golubic, et al., 2009). A second international study revealed that night shift nurses who felt autonomous, appreciated and supported by management also had higher levels of job satisfaction than those who did not (Gustafsson, Fagerberg, & Asp, 2010). This article as well as two others concur that supportive leadership is a major factor in night shift job satisfaction (Gustafsson, et al., 2010; Blachowicz & Letizia, 2006; Claffey, 2006).

An Australian study also showed a link between education and work attitudes (Johnson, Hong, Groth, & Parker, 2011). This study also pointed out that learner input improved both participation in the research and the continued performance of the material (Johnson, et al., 2011). Besides having more physical ailments than their counterparts, night shift nurses experience fatigue and sleep deprivation more often. (Blachowicz & Letizia, 2006; Claffey, 2006). Both these sources recommend that night workers maintain their sleep schedules, even when not working (Blachowicz & Letizia, 2006; Claffey, 2006).

Summary

While the factors that influence job satisfaction of night shift nurses are varied, convenient access to required education is important. Whatever time education is offered, it needs to have consistent curricula and standardized assessment tools. Education is most effective when the adult learner participates in the planning and teaching process.

Chapter 3: Methodology

Introduction

This chapter discusses the methodology used for this critical action design. It describes the target audience and learners. The role of the participants and the groupings are articulated. The settings are carefully described. The methods, types of data collection, instruments utilized, and kinds of data analysis are also discussed.

Research Design and Approach

Based on the problem, the proposed research questions, and goals, an inductive cross-sectional critical action approach was utilized. Both quantitative and qualitative data were collected. According to Gay, Mills, and Airasian (2009), this study meets the critical action perspective because it was participatory (night shift nurses) and democratic (the participants had input on what times the in-services took place). It was socially responsive because it addressed the learning needs of professional nurses, and it took place in the context of the facility where the participants practice (Gay et al., 2009). In addition, it was relevant to the night shift nurses because it investigated a problem they actually have (lack of convenient access to required courses) (Gay et al., 2009). It was accessible because the study evaluated the participant's use and perceptions of any professionally-oriented courses over the past two years.

Further, the study met the critical action component of examining the general practice of day time content delivery because it adapted curricula to the specific learning needs of night shift nurses and studied the impact on job satisfaction (Gay et al., 2009). Lastly, this study was appropriate for action research because a strategy is presented to guide other nurse educators with launching required course work at night (Gay et al., 2009).

Setting

One setting was a home care company with 42 part-time and full-time nurses. The other utilized the membership of a well-known nursing social media website. The online participants worked in a variety of settings, and are located across the United States.

Sampling techniques and participant demographics

Purposive sampling was used to obtain participants who are nurses whose work schedule is at night (1900-0730) or evenings (1500-2330). Full-time and part-time employees participated. Members' ages were from early 20's to 60+ and consisted of various cultures. Males and females were represented as they existed in the facility's work force. Sample size was 26. The night shift sample was given the job satisfaction survey after the intervention to illustrate significance. The educational level was at least diploma, and included employees with undergraduate or graduate degrees.

Appropriateness of sampling techniques

Purposive sampling was most appropriate because this study was about assessing and addressing the learning needs and job satisfaction of a specific group of people (nurses who work nights) (Gay, et al., 2009).

Research questions

How did offering required coursework at night affect job satisfaction?

What kind of courses/training could feasibly be offered during these hours?

Data Collection Methods

This study utilized questionnaires regarding the participant's frequency of attendance, perceived bedside usefulness, and attitudes about Annual Competencies. The author prepared the survey using Google docs, and results were automatically tabulated into an Excel spreadsheet. This technique nearly eliminated mathematical error, bias and pre-conceived notions about results. A pre- and post-intervention survey was used to assess job satisfaction of participants. Job satisfaction was queried from a similar number of day shift nurses, and compared to with those of the night shift participants.

Quantitative data consisted of nurse's existing education, plans for pursuit of advanced education or professional certifications, and length of time of employment as a nurse (see Table 2). Qualitative data consisted of opinions about perceived usefulness of facility-required education, job satisfaction, and opinions about management's support of educational goals and keeping staff informed regarding work-related topics (see Table 1). Instruments

A Likert scale using five degrees of satisfaction was used for the job satisfaction surveys (see Table 1). Interviews were conducted to assess participant's attendance and perceived usefulness of mandated education. Additionally, night shift nurses were asked for their input on what job-related education they would like offered in the future and what times would be most convenient to attend these courses (see Table 3). The researcher utilized the two most frequently suggested times to deliver the Basic Life Support (BLS) Renewal class and the Surviving Sepsis Competency review. A post-intervention job satisfaction survey was conducted with the night shift staff.

Data Collected

Primary data collection methods were used for this query. This method was most useful to obtain the answers to the research questions. Survey research is determined as best when one desires to obtain opinions and beliefs about a topic, such as job satisfaction (Gay et al., 2009). Quantitative data were collected to tabulate what degree or diploma participants had, and how long they have been licensed (see Table 2). Specifically, most of the quantitative data were ordinal, which were converted to interval for ease of analysis. The job satisfaction survey was an eight-item Likert scale using five levels of satisfaction (Table 1). The job satisfaction survey, adapted (NBRII, 2012) and author-customized, was given to a randomly-selected purposive sample of day shift nurses and night shift nurses. Responses from each of the eight questions were calculated within the groups and compared among both groups using a one-way and repeated-measures analysis of variance (ANOVA) (Table 4). The one-way and repeated-measures ANOVA are Table 6 and Table 8, respectively.

A pre-intervention and post-intervention job satisfaction survey was administered to the night shift participants and compared to illustrate improvement in job satisfaction. The data analysis allowed the researcher to compare an individual's change in job satisfaction, as well as compare responses from the two shifts. The researcher desired to test the empirical belief that a difference in job satisfaction existed between the day shift and the night shift employees. Highest possible points on the Likert scale job satisfaction survey was 40 (eight "strongly agree" questions ranked at five points each). This allowed ordinal data to be converted to interval data. The level of significance for this study was arbitrarily determined to be p= .05. An F statistic was calculated, and compared to a t critical value table with df 1, 25. Standard statistical analysis teaches that if the F is greater than or equal to t crit, the null hypothesis is rejected, i.e., offering night classes had no effect on job satisfaction (Thorne & Giesen, 2003). Pre-intervention interviews with participants were conducted to ascertain use and access of continuing education or other required courses (Table 2). The interviews consisted of unstructured questions (Table 3). Qualitative answers to the open-ended questions were coded and grouped into themes.

Post-intervention unstructured interviews were held with participants to clarify researcher concerns, and to explore changes in levels of job satisfaction. Interviews lasted between 10-30 minutes, and were digitally recorded for later transcription. Samples of the open-ended post-intervention interview questions can be found on Table 3.

Research Procedure

Prior to the beginning of this study, necessary facility permissions were obtained from the Vice President of Operations, who was consulted regarding regulatory and logistical concerns (Appendix D). Organizational approval was also received from the Administrator at a respected nursing website (Appendix D). Informed Consent was obtained from all participants (Appendix A).

A job satisfaction survey was given to 26 active full-time and part-time nurses (see Table 1). The study survey was available for approximately 30 days online. After receiving sufficient participants, the link to the survey was closed.

Rationale for Offering AHA BLS Courses

American Heart Association (AHA) Basic Life Support (BLS) is a bi-annual requirement of almost every health care provider. Materials are evidence-based, pre-packaged and easily teachable. The author has been a BLS Instructor for six years, and attends Emergency Cardiovascular Care updates every two years. The staff attending these classes did not pay any tuition fees, but they did purchase the cards and Student Handbook.

Rationale for Offering Sepsis Competencies

The author has previously utilized protocols from the internationally-recognized Surviving Sepsis Campaign (Ehrig, 2011). These materials are evidence-based (www.SurvivingSepsis.org). Re-using previously developed materials was a time-saving strategy. When treating patients with sepsis, all facilities visited by this researcher utilized protocols similar to those of Surviving Sepsis. Sepsis prevention and treatment protocols are frequently part of a facility's Annual Competency training. The curricula met or exceeded regulatory requirements.

Timeline

The time from facility and VP approval to participant selection lasted two weeks. Information sessions and Informed Consents took place over two separate weekend nights. Job Satisfaction surveys (Table 1) were given to the selected participants on two separate weekend days, and on two separate weekend nights to the selected night shift nurses at the time of the information sessions. The Demographic Questions (Table 2) were conducted at the time of the information sessions. The BLS Renewal Classes were scheduled a week apart. The Surviving Sepsis courses were offered a week apart on different nights than the BLS classes. BLS and Surviving Sepsis courses were offered at the times suggested/recommended by the majority of the participants. Post-intervention job satisfaction surveys were administered immediately following the last course. From participant selection to completion of the data analysis took about four months.

Researcher's Role and Bias

The researcher's role was to conduct the study according to accepted scientific research principles. She designed the interviews, collected quantitative data on participant's attendance, delivered the coursework during night hours, evaluated and verified results, and implemented the instructional materials guided by the unique learning needs of the participants. One author bias was that she has been a night shift nurse required to attend Professional Development, Annual Competencies, and other mandatory education. Due to the fact that these courses were not offered during night time hours, she and her night shift co-workers needed to abruptly adjust their sleeping patterns to attend during the day. The author and her co-workers expressed general job dissatisfaction because required courses were not available during the normal working hours of a sizable portion of the workforce, which is a given for their day shift counterparts. If nearly half of the bedside workforce works at night, then an equal share of required education needs to be offered at night.

Data Analysis

The purpose of this study was to offer required nursing courses during the normal work hours of the night shift nurse, and to test for significance on improving job satisfaction. Quantitative data was analyzed by using ANOVA. This allows an objective means to review the results from the Demographic Interview (Table 2). Responses to the non-structured Post Intervention Interview (Table 3) were coded and grouped into themes as they developed. Common themes were analyzed by inferential methods. Responses from the qualitative Job Satisfaction Survey (Table 1) were input on a Microsoft Excel spreadsheet. Qualitative data such as Job Satisfaction can be converted to quantitative data by assigning numerical labels to each level of agreement.

The author labeled the response "Strongly Agree" as a 5, "Agree" as a 4, and so on. This method allowed an arithmetic calculation of each person's Job Satisfaction score. In this study, an individual could have a maximum satisfaction score of 40 (eight questions answered as "Strongly Agree") and a minimum of 8 (eight questions answered as "Strongly Disagree"). The author desired to compare pre- and post- intervention scores and test for significance. Therefore, a repeated- measures ANOVA was performed and compared to t crit (Table 8). Further, the author desired to test the belief that a difference in job satisfaction exists between the two shifts. Job Satisfaction ratings were obtained from all participants and grouped by which shift the nurses worked. Then, a one-way ANOVA was used to test this belief (Table 6).

Human Subjects Protection

Informed Consent was obtained from each participant (Appendix A). The purpose of the study, risks and benefits of participation, and freedom to withdraw from the study were discussed in an Information Session that lasted 20 minutes for each of the two in-person groups. The author/researcher's contact information was an integral part of the Informed Consent (Appendix A).

Since this study involved human participants, the author completed the National Institute of Health Office of Extramural Research online training course of "Protecting Human Research Participants" (Appendix B). This author utilized methods to protect the anonymity of the in-person participants. For example, interviews were conducted in private, away from the work area, and participants were requested not to reveal their participation to anyone outside the classes. Of course, during the classes, participants had the opportunity to interact with one another. However, this author will not release any participant's name or other identifying information, such as workplace or unit worked either during or after the study.

Each participant received the exact same Job Satisfaction survey, Demographic Questionnaire, and Post Intervention Interview questions. Day shift nurses did not complete the post-test Job Satisfaction survey or the Post-Intervention Interview. The author did not change or eliminate any responses. In fact, with the online Google docs being automatically imported into a Microsoft Excel spreadsheet, it was impossible for the author to manipulate responses. The link to the survey was closed after sufficient participants were obtained.

All instruments and demographic data were stored on flash drives and an encrypted, fingerprint-secured notebook computer accessible only to this author. Names of facilities or participants will not be revealed at any time. A copy of the Capstone will be made available to the Administrators and Managers of the facilities that the author visited during her research. As a condition of utilizing the membership of the major nursing website, the author agreed to publish her Capstone as an article on that website. Members use screen names, and not their actual names. Online anonymity is protected because the author did not collect any personally identifiable information from the online participants.

Paper documentation, such as in-person Informed Consent, Job Satisfaction surveys and evaluations, will be shredded once the Capstone is completed and approved.

Rationale for Choosing Data Analysis Tools

Coding and organizing into themes is an accepted practice when examining qualitative data (Mills, 2007). This study involved qualitative data. Action research literature highlights several techniques and sources that are used in this study (Mills, 2007). Some of the data occur naturally, such as access to and use of required coursework. Nurses routinely provide this data to licensing boards in states that mandate continuing education, and usually to their employers. When examining quantitative data, many tools are available. A one-way repeated measures ANOVA allows the researcher to calculate the F statistic, which can then be compared to a table showing tcrit with df 1,25, p <.05 or <.01. When the t value is less than F, the researcher rejects the null hypothesis; in this case, attending courses during one's normal work hours had no effect on job satisfaction (Thorne & Giesen, 2003). This study also employed quantitative data. A repeated measures ANOVA is used when examining results of a study with one group of participants who are exposed to more than one intervention. In this case, the intervention is the night time education. Additionally, a one-way ANOVA was used to view results of the job satisfaction survey for the day shift and night shift nurses. This test is used for comparing results from two different groups. The author desired to test whether job satisfaction differed between the two shifts.

Interpretation of Results

The results assisted with answering the research questions, as well as suggesting ideas for future study. At the very least, results may be interpreted as sufficient to provide a framework for offering other night shift courses. Further, the researcher has already had discussions with the Vice President of Administration and the Chief Clinical Officer about broadening the course offerings that are scheduled at night.

Summary

While attending mandatory education is the norm for many nurses, few courses are available during the working hours of night shift nurses. There is not much literature available that utilizes this segment of the work force as participants. This study demonstrated the positive impact on job satisfaction when attending required courses during one's usual duty time. Expanding the course offerings to all night shift staff and making required courses available at other facilities is expected to make a positive impact on job satisfaction for this group of workers.

Chapter 4: Findings

Introduction

The data for this Capstone study were collected from in-person interactions and from an online survey created by this researcher. Participants were all currently licensed and practicing RN's who live across the United States. Data were collected over approximately one year. However, the bulk of it was collected during August and September, 2013. This researcher utilized surveys, questionnaires, and interviews to gather data. The majority of data were collected in an online survey that was initiated and reviewed by this researcher. She also gathered data in person at hospital facilities and a home care company where she either worked or had professional relationships with key administrative personnel. The online participants belonged to a major nursing-oriented website with membership numbers of over 750,000. The home care company nurses represented about one-sixth of the nurses employed there.

Once purposive methods were employed to obtain nurses who normally work evening or night shift, all respondents participated on a voluntary basis. In-person respondents were paid by their employer for their time to attend the classes. However, the employer normally pays for employee's time when attending mandatory training. For the online participants, the researcher made a request for participation on one of the topic-specific areas of the website. Members had complete control of whether or not to participate in the survey. Unless those persons happened to be working at the time they answered the survey, they were not paid.

Nursing experience ranged from novice (less than two years) to expert (more than ten years). Cultural and gender information was not collected from the online participants. Job Satisfaction data and interviews were conducted between August and September, 2013. All data were gathered, analyzed, and examined by this researcher. Answers from the online survey on Google docs were automatically imported into a Microsoft Excel spreadsheet, which were analyzed by the author. The responses gathered in person were also only reviewed and analyzed by this researcher. She utilized graphs and both one-way and repeated-measures ANOVA to display results as discussed below.

Analysis of Data

The data from the Job Satisfaction Survey (Table 1) and the Demographic Questionnaire (Table 2) were obtained from the online tool, Google docs and automatically imported into an Excel spreadsheet. The researcher also tabulated the results from the in-person surveys and transcribed them into the same spreadsheet.

Diane is a passionate Nurse Educator. She worked as a Staff Nurse on night shift, and found that no employer-required courses were available during her normal work hours. During her undergraduate coursework, she decided to offer one American Heart Association Basic Life Support class during the night shift. Her co-workers/"participants" were so elated about this and asked for more classes. Diane decided that this issue was worthy of graduate-level research using accepted scientific methods. She hopes that many facilities will adopt similar practices. Diane is an Independent Contractor at a local Health Education company as a Clinical Nurse Educator. She also frequently works in ICU. Her favorite clinical area is Neuro ICU.

liebling5 has '9' year(s) of experience and specializes in 'Stroke Seizure/LTC/SNF/LTAC'. From 'California'; 57 Years Old; Joined Mar '05; Posts: 145; Likes: 115.

This is excellent information. Hopefully hospitals and schools will take notice of studies like these. Circadian rhythms are not to be trifled with, and disruption has very real and significant effects.

I think we all understand that it's counterproductive and thoughtless not to have inservice offerings on all shifts proportionate to the number of people who work them. Studies have shown that for years. However, I have some questions about your methods and conclusions that perhaps you could clarify. I think your analysis and conclusions sections got cut here?

The tables do not appear here. Could you clarify their contents?

How many of your 26 respondents were known current night shift workers at the home care company, and how many anonymous and therefore unverifiable were from an online poll? What were their numbers, ages, and years of employment, and years of experience of each? These might be significant variables in job satisfaction. These data may also be in your tables, sorry.

What were the factors determining dissatisfaction with working night shift? How important were they in rank to availability of inservice education? For example, did new grads working nights because it's the only shift available to them rank lack of inservices higher as a factor than sleep disruption in general, lack of quality time with family/friends, lack of support, short staffing, or other factors? These may appear in your tables but I can't tell.

How did you control for rotating shifts, or were all night shift workers full-time nights only?

Thanks for an interesting read. I look forward to your clarifications.

[QUOTE=GrnTea;7690245]I think we all understand that it's counterproductive and thoughtless not to have inservice offerings on all shifts proportionate to the number of people who work them. Studies have shown that for years. However, I have some questions about your methods and conclusions that perhaps you could clarify. I think your analysis and conclusions sections got cut here?

Hi GrnTea - You ask some excellent questions. Yes, unfortunately, my Analysis and Conclusions sections did get cut by the Admins. My school (Western Governors University) did not allow me to mention any facility names, or even the fact that my "online" respondents were/are members of Allnurses. Perhaps, now that WGU approved my thesis, I can edit it to mention Allnurses.

Your Question 1: Nine of the 26 respondents were night shift nurses at the home care company. The rest were/are members of Allnurses.

Question 2: The tables do show ages of the respondents in 10-year blocks, length of employment as a nurse, and educational level.

Question 3: The Job Satisfaction survey was an 8-item Likert scale tool. The respondents picked from one of five levels of agreement with each question. The eight items I used were: My facility values individual employees; I have access to information needed to do my job; My manager keeps me well informed; My employer treats me with respect; I enjoy working here; Management supports my professional growth; Employer-required competencies are helpful at the bedside; I feel important to the health care team. Every participant answered all the questions.

I also asked several demographic questions about plans to pursue a higher degree or specialty certifications, and how likely would one attend Annual Competency courses if they were offered at night.

The majority of my respondents have been nurses for ten years and about half have at least a Bachelor's degree.

I also gave the Job Satisfaction survey to 26 day shift nurses, both from the home care company and places I've worked as a traveler, staff, or registry.

Your Question 4: Only 2 people replied that they worked "something else" other than 12-hour days or 12-hour nights. My questionnaire asked what shift was mainly worked, ie., 12-hour days, 12-hour nights, or "something else." I got 2 of the online respondents who answered "something else." I didn't question further if those were people whose shifts rotated between days and nights. I did not exclude part-time or per diem nurses from the online questionnaire, but I did exclude per diem nurses from my in-person study because of time constraints (theirs and mine).

Many places I've worked in California, Kansas, and Missouri do NOT offer in-services and Annual Competency validations during night shift. My first facility, a very large teaching Magnet-designated hospital, did not offer any in-services during nights while I was there.

I may have missed it, but how did you determine how important lack/presence of night-shift educational offerings was, as related to job satisfaction? I mean, were the night workers reporting that it was the most important factor in their job satisfaction ratings, middling, or not so much? if your hypothesis is that it was very important to job satisfaction, how do you know?

And how can you be sure that the two-thirds of your respondents were really night shift RNs? Only 6 live respondents in home care (and "other places"-- what kind?) doesn't say "Generalizable to hospital setting" to me, but perhaps you had some more info that was cut.

Thanks so much for responding. MAybe you'll be in a position to do a more controlled study when you're a full-tie inservice person!